Current guidance suggests that GLP-1 (glucagon-like peptide 1) receptor agonists be held preoperatively due to an increased risk of pulmonary complications, but large-scale data examining this risk have been missing. This retrospective observational study of healthcare claims data examined the incidence of postoperative pulmonary complications, defined as aspiration pneumonitis, postoperative respiratory failure, or intensive care unit admission within 0 to 7 postoperative days among 3,502 patients using GLP-1 receptor agonists who underwent emergency surgery and were therefore unlikely to have withheld their medication. A total of 20,177 diabetic patients undergoing emergency surgery who did not use GLP-1 agonists were used as a control group. After adjustment for confounders such as diabetes severity, the incidence of pulmonary complications was 4.0% among the GLP-1 group compared to 3.9% among the controls (odds ratio, 1.03; 95% CI, 0.82 to 1.29; P = 0.80). Study limitations included lack of consideration of specific intubating techniques used (e.g., rapid sequence intubation) and limitation of the cohort to diabetics alone without consideration of patients using the drugs for weight loss.

Take home message: This retrospective analysis of healthcare claims data for patients undergoing emergency surgery comparing outcomes among patients using GLP-1 agonists to a control group of diabetic patients found these drugs were not associated with an increased risk of pulmonary complications.